2025 Volume 118 Issue 11 Pages 839-844
Although the number of cases of tuberculosis (TB) in Japan has been decreasing and the country was declared as “low endemic” for TB for the first time in 2021, cervical tuberculous lymphadenitis should always be considered in the differential diagnosis of patients presenting with cervical lymphadenopathy. Between 2014 and 2023, we encountered 15 cases of cervical tuberculous lymphadenitis. The patients included 6 males and 9 females, ranging in age from 24 to 88 years (mean age, 57.7 years). Pulmonary tuberculosis was present in only one of the 15 patients, and one patient also had a past history of tuberculous lymphadenitis. Two patients had coexisting diseases that could potentially cause cervical lymph node metastasis.
None of the cases were suspected as cases of tuberculosis based on fine-needle aspiration cytology (FNAC), and inflammatory cells were observed in all of the 14 cases in which aspiration was performed. Atypical cells were found in one case. The diagnostic sensitivities of smear, culture, and PCR testing for acid-fast bacilli were 20%, 66.7%, and 53.3%, respectively. Histopathological examination of lymph node biopsy specimens obtained in 12 cases showed epithelioid granulomas with (11 cases) or without caseous necrosis (1 case). Presence of acid-fast bacilli was confirmed by Ziehl-Neelsen staining of the tissue specimens in 33.3% of cases, and immunological testing by T-SPOT revealed a positive result in 92.3% of cases.
The differential diagnosis of cervical tuberculous lymphadenitis is broad, and the low sensitivities of individual tests often makes definitive diagnosis challenging. When performing lymph node biopsies, it is important to consider tuberculous lymphadenitis and to evaluate the findings comprehensively by combining various diagnostic tests.
